Safe and Successful Surgical Outcome in Persons with Hemophilia A with and without Inhibitors Treated with Emicizumab: A Large, Single Center, Real-World Experience.

Emicizumab is a humanized recombinant bispecific antibody, bridging together activated factor IX (FIXa) and factor X (FX), thus mimicking the activity of FVIII in vivo. Emicizumab is designed for long-term prophylaxis in patients with severe hemophilia A with and without inhibitors. This approach provides constant protection, with significant reduction in bleeding rate and improved quality of life. However, protection provided by emicizumab is not absolute, and clotting factor concentrates (FVIII, rFVIIa, aPCC) may be necessary for post-traumatic bleeding or surgery, with a potential thrombotic risk or difficulty in preventing bleeding. Real world evidence is still scanty, especially for managing major surgery. In this study, 75 surgeries were managed in 28 patients (27 major procedures in 15 patients and 48 minor procedures in 20 patients. In 17 patients without inhibitors, 30 minor surgeries were carried out by using FVIII in 5, with only a bleeding event, which was successfully treated with FVIII concentrate. Six major surgeries were uneventfully performed with FVIII concentrate. Eleven PWHA and high-titer inhibitors underwent 39 surgical procedures (18 minor and 21 major surgeries). Minor surgeries were mostly performed without prophylaxis with rFVIIa, with only a single bleeding complication. All 21 major surgeries were covered with a homogeneous protocol using rFVIIa. In four instances, bleeding complications occurred, treated with rFVIIa. Of them, a single patient only failed to respond and died because of an uncontrollable bleeding from a large ruptured retroperitoneal pseudotumor. Surgery in patients with emicizumab can be safely carried out with the use of appropriate replacement therapy protocols.

Association of Smoking Habits and Height of Residual Bone on Implant Survival and Success Rate in Lateral Sinus Lift: A Retrospective Study.

The primary aim was to evaluate the association of patient-related factors, biomaterials, and implant characteristics on complications' rate of sinus graft surgery and on implant survival rate in grafted sinus. Secondary aims were to measure bone remodeling around implants and patient satisfaction. A retrospective cohort study was designed. Patients who had computerized tomography (CT) before sinus surgery (T0), orthopantomography after implant surgery (T1) and at follow-up (T2), were included. Specific forms were used to collect clinical data. Radiographic measures were: height of residual bone before sinus surgery measured on CT (T0) and apical and marginal bone levels around implants measured on orthopantomography at T1 and T2. Forty-three lateral sinus lifts were performed. Three grafts failed before implant insertion. Out of 83 implants inserted in 29 patients, a total of 19 failed. Mean follow-up (T2) was 6 ± 1.8 years [4; 11.2 years]. The multilevel models analysis showed no association between complications rate and patient-related factors, biomaterials, and implant characteristics. Smoking (odds ratio [OR]: 8.3; 95% CI 1.46-48.05, P = .0173) and height of residual bone (OR: 0.32 for each mm; 95% CI 0.15-0.68, P = .0034) were associated with implant failure. Bone remodeling between T1 and T2 was -0.8 ± 0.2 mm for apical bone and -0.6 ± 0.3 mm for marginal bone. General therapy satisfaction measured in a visual analogue scale was 8.4 ±1.4. In conclusion, lower height of residual bone before sinus surgery and smoking habits had a negative prognostic effect on survival rate of dental implants placed in grafted sinuses.

Xenogeneic collagen matrix versus connective tissue graft for buccal soft tissue augmentation at implant site. A randomized, controlled clinical trial.

BACKGROUND: Peri-implant soft tissue may be critical to prevent inflammation and promote gingival margin stability. The purpose of this randomized clinical trial (RCT) is to compare xenogeneic collagen matrix (XCM) versus connective tissue graft (CTG) to increase buccal soft tissue thickness at implant site. MATERIALS AND METHODS: Soft tissue augmentation with XCM (test) or CTG (control) was performed at 60 implants in 60 patients at the time of implant uncovering. Measurements were performed by a blinded examiner at baseline, 3 and 6 months. Outcome measures included buccal soft tissue thickness (GT), apico-coronal keratinized tissue (KT), chair time and post-operative discomfort. Visual Analogue Scale (VAS) was used to evaluate patient satisfaction. RESULTS: After 6 months, the final GT increase was 0.9 ± 0.2 in the XCM group and 1.2 ± 0.3 mm in the CTG group, with a significant difference favouring the control group (0.3 mm; p = .0001). Both procedures resulted in similar final KT amount with no significant difference between treatments. XCM was associated with significant less chair-time (p < .0001), less post-operative pain (p < .0001), painkillers intake (p < .0001) and higher final satisfaction than CTG (p = .0195). CONCLUSION: CTG was more effective than XCM to increase buccal peri-implant soft tissue thickness.

The effect of strontium chloride on human periodontal ligament stem cells.

The complete repair of periodontal structures remains an exciting challenge that prompts researchers to develop new treatments to restore the periodontium. Recent research has suggested strontium ion to be an attractive candidate to improve osteogenic activity. In this study, we have isolated a clonal finite cell line derived from human periodontal ligament (PDL) in order to assess whether and in which way different doses of SrCl2 (from 0.5 to 500 µg/ml) can influence both the proliferation and the mineralization process, for future application in oral diseases. PDL cells were cloned by dilution plating technique and characterized by FACS. Cell proliferation analysis and mineralization were performed by [3H]-thymidine incorporation and spectrofluorometric assay. Results have evidenced that the higher SrCl2 concentrations tested, from 25 to 500 µg/ml, have increased the proliferation activity after only 24 h of treatment. Interestingly, the same higher concentrations have decreased the mineralization, which was conversely increased by the lower ones, from 0.5 to 10 µg/ml. Our findings suggest the possible use of SrCl2 in appropriate delivery systems that release, at different time points, the specific dose, depending on the biological response that we want to induce on periodontal ligament stem cells, providing a more efficient periodontal regeneration.

Molecular, Cellular and Pharmaceutical Aspects of Filling Biomaterials During the Management of Extraction Sockets.

After a tooth extraction both hard and soft tissues undergo dimensional changes. The use of a ridge preservation technique at the moment of the tooth extraction could help could help to prevent the volume loss, thus simplifying the subsequent prosthetic and/or implant therapy. Some studies were conducted in order to examine the biomaterials and the surgical technique used for ridge preservation procedures. Clinical, histological, volumetric and molecular outcomes were registered and analyzed in different studies, in order to comprehend the biological events and the consequences of a socket preservation procedure and to allow the clinician to make the correct choice.

Root coverage procedures improve patient aesthetics. A systematic review and Bayesian network meta-analysis.

BACKGROUND: The aim of this study was to perform a systematic review (SR) of randomized controlled trials (RCTs) to explore if periodontal plastic surgery procedures for the treatment of single and multiple gingival recessions (Rec) may improve aesthetics at patient and professional levels. MATERIAL AND METHODS: In order to combine evidence from direct and indirect comparisons by different trials a Bayesian network meta-analysis (BNM) was planned. A literature search on PubMed, Cochrane libraries, EMBASE, and hand-searched journals until January 2016 was conducted to identify RCTs presenting aesthetic outcomes after root coverage using standardized evaluations at patient and professional level. RESULTS: A total of 16 RCTs were selected in the SR; three RTCs presenting professional aesthetic evaluation with Root coverage Aesthetic Score (RES) and three showing final self-perception using the Visual Analogue Scale (VAS Est) could be included in a BNM model. Coronally Advanced Flap plus Connective Tissue Graft (CAF + CTG) and CAF + Acellular Dermal Matrix (ADM) and Autologous Fibroblasts (AF) were associated with the best RES outcomes (best probability = 24% and 64%, respectively), while CAF + CTG and CAF + CTG + Enamel matrix Derivatives (EMD) obtained highest values of VAS Est score (best probability = 44% and 26%, respectively). CONCLUSIONS: Periodontal Plastic Surgery (PPS) techniques applying grafts underneath CAF with or without the adding of EMD are associated with improved aesthetics assessed by final patient perception and RES as professional evaluation system.

Surgical Treatment of Oroantral Communications.

BACKGROUND: Oroantral communication (OAC) can be defined as a pathologic space created between the maxillary sinus and the oral cavity.This communication and subsequent formation of a chronic oroantral fistula is a common complication often encountered by oral and maxillofacial surgeons.Although various techniques have been proposed in published studies, long-term successful closure of oroantral fistulas is still one of the most difficult problems confronting the surgeon working in the oral and maxillofacial region.The decision of which treatment modality to use is influenced by many factors, such as the amount and condition of tissue available for repair, the size and location of the defect, the presence of infection, the time to the diagnosis of the fistula. OBJECTIVE: To evaluate an alternative technique for the treatment of oro-antral fistula, using a combined therapeutic ear nose and throat/intraoral approach. METHODS: Twelve consecutive patients affected by complicated OAC were included in this study.The protocol consisted of: clinical, endoscopic, and radiological preoperative evaluation (panoramic tomogram and computed tomography); systemic antibiotic and steroid therapy for 2 weeks before surgery; one-stage surgical procedure consisting of Functional Endoscopic Sinus Surgery technique associated with the closure of the OAC by a titanium mesh and a mucoperiosteal flap; postoperative antibiotic and cortisone-based therapy.A titanium mesh was used to obtain an optimal support and stabilization of soft tissues.Follow-up consisted of weekly clinical evaluation during the first month, a clinical evaluation at 1, 3, 6, 12, 24 months and a nasal endoscopy at 3, 8, 24 weeks after surgery. A second surgical step took place to remove the mesh, after a period of healing, which went from 6 to 18 months. Samples were harvested from the surgical site after mesh removal for histological analysis. RESULTS: At 1 month follow-up, in 10 patients of 12, the Valsalva manoeuvre was negative, same result at the 3rd month follow-up, although in 11 of 12 patients. In 5 of 12 patients, the mesh was exposed. The histological analysis confirmed the formation of a pseudo-periosteum layer.One patient failed because the mesh lost its stability. The patient was operated again 8 months later and new mesh was fixed into place. CONCLUSION: The current study showed that one-stage, combined endoscopic and intraoral approach represents a feasible and minimally invasive procedure for the long-term effective treatment of chronic complicated OACs.The main advantage of the use of a titanium mesh to guide the regeneration is that it assures a predictable healing, mechanic scaffold, tissues stability and allows a possible following oral rehabilitation.

Effect of Surgical Intervention for Removal of Mandibular Third Molar on Periodontal Healing of Adjacent Mandibular Second Molar: A Systematic Review and Bayesian Network Meta-Analysis.

BACKGROUND: The aim of this systematic review is to evaluate and synthesize scientific evidence on the effect of surgical interventions for removal of mandibular third molar (M3M) on periodontal healing of adjacent mandibular second molar (M2M). METHODS: The protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews) as CRD42012003059. Medline, Cochrane, and EMBASE databases were interrogated to identify randomized controlled trials (RCTs) up to December 22, 2014. Patients with M3Ms fully developed, unilaterally or bilaterally impacted, were considered. Outcomes were clinical attachment level gain (CALg) and probing depth reduction (PDr) with a follow-up ≥ 6 months. Patient-subjective outcomes, such as pain, discomfort, and complications, and financial aspects and chair time, were also explored. A Bayesian network meta-analysis model was used to estimate direct and indirect effects and to establish a ranking of treatments. RESULTS: Sixteen RCTs were included and categorized into four groups investigating the following: 1) regenerative/grafting procedures (10 RCTs); 2) flap design (three RCTs); 3) type of suturing (one RCT); and 4) periodontal care of M2M (two RCTs). Guided tissue regeneration (GTR) with resorbable (GTRr) and non-resorbable (GTRnr) membrane and GTRr with anorganic xenograft (GTRr + AX) showed the highest mean ranking for CALg (2.99, 90% credible interval [CrI] = 1 to 5; 2.80, 90% CrI = 1 to 6; and 2.29, 90% CrI = 1 to 6, respectively) and PDr (2.83, 90% CrI = 1 to 5; 2.52, 90% CrI = 1 to 5; and 2.77, 90% CrI = 1 to 6, respectively). GTRr + AX showed the highest probability (Pr) of being the best treatment for CALg (Pr = 45%) and PDr (Pr = 32%). Direct and network quality of evidence were rated from very low to moderate. CONCLUSIONS: To the best of the authors' knowledge, the present review is the first one to evaluate quantitatively and qualitatively the effect of different interventions on periodontal healing distal to the second molar after extraction of the third molar. GTR-based procedures with or without combined grafting therapies provide some adjunctive clinical benefit compared to standard non-regenerative/non-grafting procedures. However, the overall low quality of evidence suggests a low degree of confidence and certainty in treatment effects. Evidence on variations of surgical M3M removal techniques based on flap design, type of suturing, and periodontal care of M2M is limited both qualitatively and quantitatively.

The Effect of Insertion Torque on the Clinical Outcome of Single Implants: A Randomized Clinical Trial.

BACKGROUND: The insertion torque value has been extensively used as an indicator for implant primary stability, which is considered a determining parameter for the implants success. PURPOSE: The primary goal of the present randomized clinical trial was to evaluate and compare the clinical outcome for implants placed with high insertion torque (between 50 Ncm and 100 Ncm) and regular insertion torque (within 50 Ncm) in healed ridges. MATERIALS AND METHODS: Partially edentulous patients, missing one or more mandibular or maxillary teeth, having an adequate amount of bone, requiring implant placement, were randomized to receive Blossom CT implants with regular insertion torque (<50 Ncm) or CT implants with high insertion torque (≥50 Ncm). Implants were left to heal submerged for 3 months. Implants were restored with individualized abutments and cemented metal-ceramic crowns. Acquired measurements were: insertion torque values (IT), thickness of buccal bone plate after implant osteotomy preparation (BBT), marginal bone level (MBL), and facial soft tissue level (FST). All patients were followed 12 months after implant placement. RESULTS: One hundred sixteen implants were placed in one hundred sixteen patients and enrolled for the study. Fifty-eight implants were randomly allocated in regular-IT and high-IT groups with a mean insertion torque ranging from 20 Ncm to 50 Ncm and from 50 Ncm to 100 Ncm, respectively. Three implants failed, and another five implants showed at the 12-month evaluation a marginal bone loss (ΔMBL) greater than 1.5 mm, being considered unsuccessful. CONCLUSIONS: The findings suggested that implants inserted with high-IT (≥50 Ncm) in healed bone ridges showed more peri-implant bone remodeling and buccal soft tissue recession than implants inserted with a regular-IT (<50 Ncm). Moreover, sites with a thick buccal bone wall (≥1 mm) - after implant osteotomy site preparation - seemed to be less prone to buccal soft tissue recession after 12 months than sites with a thin buccal bone wall (<1 mm).

Soft-tissue re-growth following fibre retention osseous resective surgery or osseous resective surgery: a multilevel analysis.

BACKGROUND: The aim of this study was to assess soft-tissue re-growth following Fibre Retention Osseous Resective Surgery (FibReORS) or Osseous Resective Surgery (ORS) over a 12-month healing period. MATERIAL AND METHODS: Thirty patients with chronic periodontitis showing persistent periodontal pockets at posterior natural teeth after cause-related therapy were enroled. Periodontal pockets were associated with infrabony defect ≤3 mm; 15 patients were randomly assigned to FibReORS (test group) and 15 to ORS (control group). Measurements were performed by a blind and calibrated examiner. Soft-tissue rebound after flap suture was monitored by changes in gingival recession at 1-, 3-, 6-, and 12- month follow-up. Multilevel analysis considering patient, site, and time levels was performed. RESULTS: Greater osseous resection during surgery and higher post surgical gingival recession was observed in the ORS group. The mean amount of soft-tissue rebound following surgery was 2.5 mm for ORS-treated sites and 2.2 mm for FibReORS-treated sites. Approximately 90% of the coronal re-growth was detectable after 6 months for both procedures. The interaction between ORS and time of observation showed a higher soft-tissue rebound after 12 months (p = 0.0233) for ORS-treated sites. CONCLUSIONS: Both procedures showed a similar coronal soft-tissue re-growth with a significant higher recession reduction for ORS-treated sites. Significant clinical stability of the gingival margin is obtained 6 months after surgery for both procedures.

Buccal bone deficiency in fresh extraction sockets: a prospective single cohort study.

OBJECTIVE: The purpose of this prospective single cohort study was to evaluate the use of xenograft and collagen membranes in treating full or partial buccal bone defects of fresh extraction sockets in the esthetic zone. MATERIALS AND METHODS: Thirty-three patients requiring tooth extraction in the anterior maxillary area and showing a complete or partial buccal bone plate deficiency (more than 2 mm) were consecutively enrolled and treated. Corticocancellous porcine bone and platelet-rich fibrin (PRF) with a collagen membrane were used to graft the extraction sockets, and the membranes were left exposed to the oral cavity with a secondary soft tissue healing. The outcome variables were as follows: width of keratinized mucosa, facial soft tissue levels, clinical bone changes (measured with a clinical splint), implant and prosthesis failures, and peri-implant marginal bone changes. RESULTS: All treated sites allowed the placement of implants; the width of keratinized mucosa at the mid-facial aspect showed an increase of 2.3 mm 5 months after the grafting procedure, and its value was 3.2 ± 0.6 mm at 1-year follow-up. The mean values of the facial soft tissue level indicated an increase over time. The bone level showed an improvement of 0.8 ± 0.1 mm and 0.7 ± 0.1 mm at mesial and distal sites, respectively, when compared to the baseline measurements. Finally, in the palatal area, no bone changes were observed. No implant failed during the entire observation period. CONCLUSIONS: Findings from this study showed that xenograft and PRF, used for ridge preservation of the extraction sockets with buccal bone plate dehiscence in the esthetic zone, can be considered effective in repairing bone defects before implant placement. The secondary soft tissue healing over the grafted sockets did not compromise bone formation; moreover, the soft tissue level and the width of keratinized gingiva showed a significant improvement over time.

Professional oral hygiene procedures do not influence plasma glucose levels in systemically healthy individuals: a short-term, randomised, controlled trial.

PURPOSE: The treatment of gingival inflammation is associated with improved glycaemic control in diabetic patients. The goal of this parallel-randomised controlled trial (RCT) was to test the shortterm effects of professional oral hygiene procedures on plasma glucose levels in systemically healthy individuals. MATERIALS AND METHODS: Systemically healthy individuals with gingivitis and no sign of periodontitis were enrolled at a private practice in Italy. Patients were randomised to either a 1 hour (h) session of professional oral hygiene procedures or to 1 h in the waiting room. Not fasting blood glucose levels were assessed by a blind examiner at baseline (T0), 1 h (T1) and 2 h (T2) after procedures and finally 1 week after (T3). Oral hygiene procedures were then performed also in the control group. RESULTS: Twenty patients were randomly allocated to each group. There were no drop-outs. Blood glucose levels at T0 (P = 0.0001) and time of measurement (P = 0.0001) were statistically significant, while oral hygiene procedures were not (mean difference between groups 0.77 mg/dl, 95%CI -2.64 mg/dl; 4.18 mg/dl, P = 0.6581). Mean blood glucose levels decreased between T0 and T1, were stable between T1 and T2 and showed similar levels to baseline after 1 week (T3) for both groups. CONCLUSION: This short-term RCT showed that professional oral hygiene procedures were not able to influence plasma glucose levels in individuals with gingivitis, but otherwise systemically healthy.

Immediate loading with LASER-treated surface implant: two-year resonance frequency analysis follow-up.

BACKGROUND: The chemical, physical, and morphologic characteristics of the implant surface play a fundamental role during the osteointegration process. Implant design is of paramount importance in determining implant primary stability and implant ability to sustain loading during and after osteointegration. LASER treatment of the surface allows defining the precise parameters of roughness to obtain a regular and repeatable surface in total absence of contamination. PURPOSE: The aim of this study was to analyze the behavior of implant stability of LASER-treated surface implants by repeated resonance frequency analysis (RFA) measurements during 2 years in patients with complete upper maxilla edentulism subject to an immediate-loading protocol. METHODS: Ten patients were included, and each treated with the insertion of 6 or 8 LASER surface implants according to the individual surgical-prosthetic planning. During the bone drilling and implant insertion, torque values were monitored with a specific handpiece and software. All implants were loaded within 24 hours from the insertion with the application of a temporary full-arch prosthesis. Subsequent follow-up has been done at 24 months from the loading with radiographic controls (OPT) and RFA measurement on all implants at time of implant insertion and at 1, 3, 6, 12, and 24 months from loading. RESULTS: Resonance frequency analyses at 3 and 6 months from the implant loading have shown a rapid increment of implant stability quotient (ISQ) values in the first phases of bone remodeling, subsequent to the peri-implant bone remodeling. The paired comparisons between mean ISQ values by patient showed a statistically significant decrease in primary stability from baseline up to 1 month (P = 0.0039). Subsequent measurements revealed a statistically significant increase in implant stability from 1 up to 3 months (P = 0.0156), from 3 up to 6 months (P = 0.0020), from 6 up to 12 months (P = 0.020), and 12 up to 24 months (P = 0.0391). CONCLUSIONS: Resonance frequency analysis of the LASER-treated surface implants showed good ISQ values at all time point measurements. These results are consistent with data from literature on the analysis of RFA in protocols of immediate loading at the upper maxilla.

An evaluation of new designs in implant-abutment connections: a finite element method assessment.

PURPOSE: This research sought first to evaluate the differences in the finite element method (FEM) analysis of 4 different implant surfaces, including internal and external connections of the same manufacturer with additional modifications. METHODS: In this study, 4 dental implants from the same manufacturer were compared. A connection system was modified with a collar to improve its stability. A nonlinear dynamic analysis by FEM was used to calculate the transient response of the dental implant systems. RESULTS: The results of FEM analysis indicated that the implant-modified configuration is more efficient in loading support when compared with the others. CONCLUSION: In the present research, 4 different types of connections were evaluated: a modified internal hex connection with a collar (to increase stability), an internal hex connection, a standard connection without hex, and an external connection. These data demonstrated that the internal hex connection with the modification of the manufacturer's original is much more resistant to loosening and/or distortion than the traditional hex.

Tissue changes of extraction sockets in humans: a comparison of spontaneous healing vs. ridge preservation with secondary soft tissue healing.

INTRODUCTION: As a consequence of extraction, the height of the buccal wall tends to decrease and results in the disappearance of bundle bone. To modify bone remodelling after extraction, various ridge preservation techniques have been proposed. The present research was drawn up with the following considerations in mind: to evaluate and to compare changes of hard and soft tissues in post-extraction sockets which received a ridge preservation procedure, with post-extraction sockets which had healed naturally. MATERIALS AND METHODS: Each patient was randomly allocated to a test or control group using a specific software package. After extraction, the sockets were carefully inspected and any granulation tissue was removed. The control sites received silk sutures to stabilize the clot without any grafting material. The test sites were grafted with corticocancellous porcine bone and a collagen membrane. All experimental sites had the membranes left exposed to the oral cavity with a secondary wound healing. The thickness of the buccal alveolar bone, if present, was carefully measured at the time of tooth extraction using a calliper at 1 mm from the edge of the wall. The following clinical parameters were evaluated at baseline and after 4 months at implant placement: vertical bone changes, horizontal bone changes and width of keratinized gingiva. The length, diameter and need for additional bone augmentation were assessed for both groups at the time of implant insertion. RESULTS: The control group showed vertical bone resorption of 1 ± 0.7 mm, 2.1 ± 0.6 mm, 1 ± 0.8 mm and 2 ± 0.73 mm at the mesial, vestibular, distal and lingual sites respectively. Moreover, changes in horizontal dimension showed an average resorption of 3.6 ± 0.72 mm. The test sites showed a horizontal bone remodelling of 0.3 ± 0.76 mm, 1.1 ± 0.96 mm, 0.3 ± 0.85 mm, 0.9 ± 0.98 mm at the mesial, vestibular, distal and lingual sites respectively. The horizontal bone resorption at the test sites was 1.6 ± 0.55 mm. The keratinized gingiva showed a coronal shift of 0.7 mm in the control group when compared to 1.1 mm in the test group. In addition, 42% of sites in the control group required an additional bone augmentation at implant placement, when compared to 7% in the test sites. CONCLUSIONS: This study clearly points out that an alveolar ridge preservation technique performed with collagenated porcine bone and a resorbable membrane--according to the procedure reported in this study--was able to limit the contour changes after tooth extraction. Finally, the test sites showed a better preservation of facial keratinized tissue when compared to control sites; grafted sites allowed the placement of longer and wider implants when compared to implants inserted in non-grafted sites.

An unusual case of unicystic intramural ameloblastoma and review of the literature.

Ameloblastoma is the most common tumor of odontogenic origin. There are various types of this tumor and confusion still exists among the clinicians about the correct classification. Multicystic ameloblastoma is the most frequent subtype while unicystic ameloblastoma can be considered as a variant of the solid or multycistic. This subtype is considered as a less aggressive tumor with a variable recurrence rate. However, its frequency is often underestimated. The aim of this article is reviewing the recent literature about unicystic ameloblastoma using our unusual clinical case as a starting point to illustrate this discussion. A 30-year-old man who had been complaining of slight pain in the premolar and molar area of the left side of mandible had a check up at our department. X-rays revealed a unilocular radiotrasparency with radiopaque margins. The first histological diagnosis was an odontogenic cyst. Successive histological evaluations revealed that ameloblastic epithelial islands were present in lassus connective tissue. We think that our case report provides new insights into the approach to the ameloblastoma diagnosis. We agree with authors who have pointed out that a single small biopsy may often be inadequate for the correct diagnosis of amelobastoma. Moreover, in the light of our experience, it should be kept in mind that ameloblastomas may have sometimes unusual presentations and this fact should induce surgeons and pathologists to consider carefully each lesion.

Biochemical markers as predictors of bone remodelling in dental disorders: a narrative description of literature.

Osteoporosis is a systemic disease in which the skeletal condition is characterized by a decreased mass of normally mineralized bone, due to an augmentation of bone resorption processes. Bone biomarkers serum are used for the diagnosis. On the other hand the main cause of the resorption in the bone jaws are periodontitis, inflammatory cysts, developmental cysts, odontogenic neoplasms. Periodontal diseases can be localized to a single site of the jaws or can affect all the teeth, with a massive bone resorption. The cysts are classified in developmental and inflammatory. They caused a local bone resorption in the jaws. Keratocystic odontogenic tumor produces a large bone resorption for its local aggressive nature. Their diagnosis is clinical and radiological.The aim of our review is to find a correlation between bone biomarkers serum and periodontitis, inflammatory cists, developmental cysts, odontogenetic neoplasms.The RANK/RANKL/OPG system is the most studied not only in osteoporosis but also in the periodontitis, inflammatory cysts, developmental cysts, odontogenic neoplasms. In the last years osteoimmunology was used to study the periodontal disease progression, because the immunity cells start the bone resorption processes.A lot of studies analyze the biomarkers present in the biofluids, as saliva and gingival crevicular fluid, but not the correlation with serum biomarkers.Future studies must be organized to deepen the correlation between bone biomarkers and bone jaws resorption and to allow diagnosis and prognosis of periodontitis, inflammatory cysts, developmental cysts, odontogenic neoplasms.

Pharmacogenetics of bisphosphonate-associated osteonecrosis of the jaw.

An undesirable effect associated with bisphosphonates is osteonecrosis of the jaw (ONJ). Case reports discussed ONJ development in patients with multiple myeloma or metastatic cancers receiving bisphosphonates as palliation for malignant bone disease. No causative relationship has been unequivocally demonstrated between ONJ and bisphosphonate therapy. To determine if a higher sensitivity to bisphosphonates could in part explain the development of ONJ, the segregation of A/C rs2297480 polymorphism of gene encoding for the farnesyl pyrophosphate synthase (FDPS) with ONJ was evaluated in a cohort of 68 Caucasian patients treated with zoledronic acid for multiple myeloma and metastatic mammary and prostate cancer. The AA and CC genotypes were highly differently distributed among ONJ patients and controls, matched for sex and type of malignant disease, with a positive correlation between AA carrier status and occurrence of ONJ (p=0.03) after 18-24 months of treatment. Because FDPS gene variants have been associated with bone morbidity, these pharmacogenetic association likely reflect the interaction of amino-bisphosphonates with germline sensitivity to drug actions, and might identify patients at highest risk to develop ONJ.

Survival rate for implants placed in the posterior maxilla with and without sinus augmentation: a comparative cohort study.

BACKGROUND: The reduced bone height and proximity of the maxillary sinus are the most common limitations for placement of dental implants in the posterior maxilla. Reconstruction of the atrophic posterior maxilla can be performed with a sinus augmentation procedure. The aim of this cohort study is to compare the survival rate of implants placed in augmented sinus to implants placed in native bone in the posterior maxilla. METHODS: This study was designed as a prospective cohort study and included consecutively treated patients. Patients who required the sinus augmentation (test group) were treated according to the two-stage technique. Patients were scheduled for follow-up evaluation at 3, 6, and 12 months after implant placement and then every 6 months for ≤ 6 years. RESULTS: One hundred and five patients with 393 implants were enrolled in the study. Two hundred and one implants were placed after preliminary sinus floor grafting in 41 patients. The control group contained 64 patients with 192 implants that were placed in pristine bone of the posterior maxilla. The cumulative implant survival rates were 86.1% and 96.4%, respectively. The difference between the two groups was highly significant (P <0.005). CONCLUSIONS: These findings show that implants placed in augmented sinuses had a lower survival rate compared to implants placed in pristine bone. All the implant failures in the augmented sinuses occurred before the prosthetic rehabilitation. Moreover, it should be considered that most of the failures were observed in few patients, thus suggesting cluster behavior.

Bone regeneration in dentistry.

The edentulism of the jaws and the periodontal disease represent conditions that frequently leads to disruption of the alveolar bone. The loss of the tooth and of its bone of support lead to the creation of crestal defects or situation of maxillary atrophy. The restoration of a functional condition involves the use of endosseous implants who require adequate bone volume, to deal with the masticatory load. In such situations the bone need to be regenerated, taking advantage of the biological principles of osteogenesis, osteoinduction and osteoconduction. Several techniques combine these principles with different results, due to the condition of the bone base on which we operate changes, the surgical technique that we use, and finally for the bone metabolic conditions of the patient who can be in a state of systemic osteopenia or osteoporosis; these can also affect the result of jaw bone reconstruction.